Quincke's edema cipher mcb. Quincke edema
There is a single normative document called the International Classification of Diseases, where a detailed description of a particular disease is recorded under each unique code. ICD is revised, corrected and supplemented every 10 years. At the moment, the ICD 10th revision is used (abbreviated as ICD-10). According to this classification, Quincke's edema has the code T78.3.
What is the classification of diseases for?
The ICD is uniform all over the world and is used to record the incidence and analytical data on health problems in people from different regions, countries, with its help, the influence of various factors is considered. Also, this document is convenient for transforming the language characteristics of the disease into an alphanumeric one, understandable to doctors around the world without translation. For example, according to ICD 10, Quincke's edema contains a brief description, and in any hospital a patient with this manifestation can be treated according to the same scheme. After all, the course of the disease itself does not differ from the country in which the patient lives.
It is known that Quincke's edema is one of the most unpleasant reactions of the body to an allergen. It is always difficult, restless, and causes a lot of inconvenience to the patient. According to ICD 10, Quincke's edema is classified as an adverse effect caused by an incompletely specified cause. Often the disease appears simultaneously with urticaria. But according to the clinical classification, there are two types of angioedema - allergic and non-allergic.
The diagnosis of "angioedema" according to ICD 10 is established on the basis of anamnesis and clinical presentation, if all similar clinical manifestations of the disease were excluded.
No specific diagnostic methods are used.
Quincke's edema can be found in ICD 10 in Class XII "Diseases of the skin and subcutaneous tissue" (L00-L99) in the block "Urticaria and erythema" (L50-L54) in the subsection "Urticaria L50" \u200b\u200bunder code T78.3.
Quincke's edema as a subspecies of urticaria
Severe urticaria is also called angioedema or Quincke's edema. Outwardly, the disease looks like a giant edema of the mucous membrane or subcutaneous tissue on the face (eyelids, lips, tongue, throat) and on other parts of the body (arms, legs, scrotum), therefore, in ICD 10, this disease is precisely in the subtype of urticaria. There are similarities between these allergic manifestations, but also differences. For example, Quincke's edema does not itch, it has a delineated area of \u200b\u200bappearance of a light red color, when pressed, no pits remain, and it is not hot to the touch.
With angioedema, the victim has the following symptoms:
- blood pressure and temperature may rise;
- he feels anxiety, headache, tingling in the area of \u200b\u200bthe disease;
- abdominal pain, possible nausea and vomiting, fever and delirium.
Quincke's edema quickly appears and disappears just as quickly, leaving no consequences, after a few hours or days.
Why does Quincke's edema have such an ICD code
However, there is a section in the International Classification of Diseases titled "Adverse Effects Not Elsewhere Classified (T78)". This part of the document is referred to when coding an undefined, unknown or not clearly indicated cause of a particular disease.
ICD 10 does not provide for an indication of the immediate cause of Quincke's edema.Such an allergic reaction can be caused by a wide variety of allergens, because their number is growing every year and it is impossible to list absolutely all risk factors. That is why the ICD 10 code for Quincke's edema consists of the code T78.3.
Setting the Quincke edema code according to ICD 10 makes it easier for the doctor and his colleagues in further work with the patient. And since angioedema belongs to the group of diseases dangerous for human life, this contributes to accurate and correct treatment.
Moreover, sometimes doctors fail to find out what triggered such an acute allergic reaction. Because of this, the mechanism for the formation of an emergency condition lies at the heart of the encryption of edema according to the ICD.
The exact code of the pathological condition is the following combination: T78.3.
Why do you need encoding?
The International Classification of Diseases is the only document in the world in which absolutely all diseases are encrypted. Moreover, the encoding is the same for all countries, so the data will look identical in any state. Thanks to the international classification of diseases, it became possible:
- keep records of morbidity around the world;
- collect and evaluate data on mortality of the population from any pathology;
- study of the etiology, risk factors and other features of a particular disease;
- develop preventive measures and forecast the epidemiological situation;
- have constant access to information about the treatment of a specific disease.
The existence of the ICD allows doctors all over the world to operate on the same patient rescue algorithms.
Every 10 years, the international classification is revised, and corrections are made to it corresponding to the new data. At the moment, the ICD revision code 10 is valid.
Features of encryption of angioedema in ICD
Quincke's edema is an acute allergic reaction of the body, which is provoked by various external factors. The condition is urgent and requires prompt medical attention. The development of such a pathological process in a child is especially dangerous, since in children it is often complicated by asphyxia.
The clinical picture of an allergic reaction is characterized by the accumulation of fluid in the interstitial space of the subcutaneous tissue or mucous membranes. In this case, a swelling of a delimited type is formed, most often of the mouth, eyelids, lips or larynx. A similar pathological condition develops almost instantly, and disappears within a few days.
Treat the disease with corticosteroids and antihistamines, as well as epinephrine. In addition, the basis of successful treatment is the elimination of contact with the allergen, which can be anything.
Quincke's edema in ICDrepresents an unfavorable response of the organism to an unspecified external influence. The etiological factor does not matter, in contrast to the clinical classification, where the pathology of an allergic and non-allergic nature is distinguished. It belongs to the class of cutaneous and subcutaneous pathologies and is located in the block of urticaria and erythema.
According to ICD 10, angioedema is considered a type of urticaria. The exact code of the pathological condition is the following combination: T78.3.
In ICD 10, it is prescribed that the diagnosis of angioedema can be established on the basis of the history of the disease and the symptoms of the patient, after excluding other pathologies. There are no specific methods for confirming pathology.
Why is Quincke's edema a subtype of urticaria?
For angioedema of any etiology, the ICD code is always the same. Pathology is considered one of the most severe manifestations of an immediate reaction. There is another similar process called anaphylactic shock. All these allergic conditions are in one subsection, as they have a similar development mechanism.
In any reaction of the immediate type, there are identical elements of pathogenesis:
- activation of the complement system;
- release of biologically active substances into the blood;
- increased permeability of the vascular wall;
- vasodilation;
- pressure drop.
The difference between Quincke's edema and urticaria is that it is localized in one place and represents a large delimited lesion area . Fluid accumulates in the mucous and deep tissues of the body, and with urticaria in the upper layers of the skin. The affected area does not itch, but the skin over it is tense. In this case, no changes in the color of the skin are observed. However, the development of angioedema often occurs simultaneously with the formation of urticaria. The pathological condition is considered a severe form of urticaria or its complication.
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Quincke's edema is one of the variants of allergic diseases, which is characterized by the lightning-fast development of pathological symptoms, due to the increased reactivity of the body.
Currently, all diseases are included in the classification, which makes it possible to systematize pathologies. Each disease is assigned a letter designation and a numerical serial number, these parameters make up the code of the international classification of diseases. In addition, these symbols help to optimize the analytical work of doctors.
Quincke's edema code ICD-10 should be sought in the group of diseases of the skin and subcutaneous fat, in the blocks of urticaria and erythema. Currently, Quincke's edema has been assigned the code T78.3.
Symptoms
The main symptom of the disease will be sharply increasing edema. It is visible to the naked eye and enlarges in a few minutes. Initially appears at the site of exposure to the allergen (these can be hands or other areas). The process necessarily involves the tissues of the face and mucous membranes of the eyes, nasal and oral cavity.
The most life-threatening and prognostically unfavorable if timely assistance is not provided is laryngeal edema. The edematous tissues initially do not differ in color from the neighboring areas, but subsequently become paler.
Edema is characterized by a pronounced tissue density: when pressing on the focus, the impression on the skin does not persist. In addition to the main symptom, the symptoms of Quincke's edema are characterized by the predominant form of damage to one system or another.
In the event that the pharynx, larynx or trachea swells, the following symptoms may occur:
- Difficulty breathing. Difficulty breathing.
- The development of severe anxiety, fear of death.
- The appearance of a pronounced barking cough.
- Hoarseness of voice.
- Change in the color of the skin of the upper half of the body. Severe pallor or cyanosis.
- Loss of consciousness.
- Edema appears, especially in the area of \u200b\u200bthe palate and palatine arches.
- Narrowing of the throat lumen with the possibility of transition to the larynx.
Quincke's edema can manifest itself not only in the area of \u200b\u200bthe upper respiratory tract or mucous membranes, but on the internal organs.
In this case, the patient suffers:
- severe abdominal pain;
- nausea and vomiting that does not bring relief;
- diarrhea;
- tingling sensations in the palate and tongue.
At the same time, visible manifestations may be completely absent, which greatly complicates the diagnosis.
The most dangerous variant of Quincke's edema is damage to the meninges. Such manifestations are quite rare, but it is precisely this that leads to serious complications. Among them:
- the appearance of lethargy and lethargy;
- development of rigidity of the occipital muscles - tilting the face forward to the chin is impossible;
- nausea not associated with food intake;
- convulsive syndrome and angioedema.
Treatment
With the development of Quincke's edema, urgent medical care is needed, since the progression of symptoms leads to a further deterioration in well-being and poses a danger to the life and health of the patient. Therefore, it is important to recognize the disease as early as possible and take the necessary measures. Treatment can be divided into two main groups: medication and non-medication.
Drug-free treatment
You should always start with non-drug methods, since it is their provision that can significantly alleviate the patient's condition.
Among them:
- Removal of the provoking factor, which acted as an allergen and led to the development of pathological symptoms.
- If Quincke's edema has developed against the background of an insect or animal bite, then a tourniquet should be applied above the site of the bite. If parts of saliva or a sting remain in the wound area, then they must be removed.
- Provide free breathing and improve air access to the respiratory tract. For this, items such as belts, ties and belts must be removed. It is advisable to remove clothes from the upper half of the body.
- Provide fresh air in the room where the patient is.
Medication methods
From medications, the following are initially used:
- Drugs of the glucocorticoid group, these include a solution of prednisolone or dexamethasone. They relieve the severity of edema, reduce the permeability of the vascular wall and improve breathing.
- Offer the patient an abundant drink simultaneously with sorbents in order to remove allergens and relieve intoxication. For this you can use activated carbon.
- Use drops that promote vasoconstriction in the nasal cavity.
- If there is a pronounced threat to the patient's life, then an adrenaline solution is used. It improves the functioning of the cardiovascular system, increases blood pressure and blood flow to vital organs.
Treatment with these funds is carried out at the pre-hospital stage. If there is no medical professional nearby, then the drug should be taken not in an injection form, but by ingestion: apply the ready-made solution under the tongue. Treatment in stationary conditions is an obligatory stage in eliminating Quincke's edema. It consists of two stages. This is the elimination of the manifestations of the disease and a decrease in the severity of symptoms associated with its appearance. These should include:
- Introduction of prednisone and adrenaline.
- To eliminate the shock state associated with a drop in blood pressure, blood substitutes such as saline, glucose, and so on are administered.
- Taking antihistamines that reduce the reaction to an allergen and diuretics, which increase not only the elimination of immune complexes and antigens, but also the fluid that is outside the vascular bed.
If Quincke's edema appears, you should immediately consult a doctor and provide emergency assistance, since the progression of the pathology is life-threatening.
Short description
Angioedema - acutely developing, rapidly passing edema of the skin and subcutaneous tissue or mucous membranes.
Etiology. Angioneurotic edema is a polyetiological disease that can be caused by both immune and non-immune factors.
. Allergic - manifestation of type I allergic reaction; develops as a manifestation of sensitization to drugs (more often antibiotics), foods and additives, the poison of stinging insects (bees, wasps and hornets).
. Pseudoallergic - as a consequence of the direct non-immune histamine - the releasing action of some drugs (salicylates and other NSAIDs, ACE inhibitors, dextrans, etc.), foods or additives (see Food Allergy).
. Complement - addicted - can be inherited or acquired (as a rule, in patients with lymphoproliferative malignant neoplasms, which is associated with an acceleration of the metabolism of the C1 esterase inhibitor of the complement component by 2-3 times).
. Idiopathic - the etiology is unclear.
Causes
Risk factors ... Atopic predisposition. Taking ACE inhibitors (in 0.2% of cases). Presumably taking omeprazole (a proton pump inhibitor) and sertraline (a selective serotonin reuptake inhibitor).
Genetic aspects. Hereditary angioedema (* 106100, deficiency of the esterase inhibitor of the complement component C1, 11p11.2-q13, deletion of the C1NH gene in type 1, point mutation in type 2, ) is characterized by recurrent episodes of edema of the skin, upper respiratory tract and gastrointestinal tract (up to to intestinal obstruction).
C1q is an inhibitor - a highly glycosylated serum protein synthesized in the liver and inhibits the proteolytic activity of the C1r and C1s subcomponents, thus preventing the activation of the C4 and C2 complement components.
Insufficiency of C1q inhibitor leads to uncontrolled activation of early complement components and the formation of a kinin-like factor, which causes an increase in vascular permeability and leads to the development of angioedema.
Most often (in 80-85% of cases), the cause of hereditary angioedema is a quantitative deficiency of C1q inhibitor (type 1), in other cases, with a normal amount of the inhibitor, the cause of hereditary angioedema is its functional inferiority of C1-inactivator due to point mutation in the reactive center of the molecule (type 2).
Pathogenesis is similar to the pathogenesis of urticaria and is associated with dilatation and increased vascular permeability (mainly venules) of the deep (unlike urticaria) layers of the dermis and submucosal layer caused by allergy mediators (histamine, PG, leukotrienes), as well as complement components (primarily C3a and C5a ) and kinins.
Pathomorphology. Edema, vasculitis and / or perivasculitis involving only the subcutaneous tissue.
Clinical picture ... Local edema of the skin, subcutaneous tissue and / or mucous membranes, with or without urticaria. Often - an integral component of a generalized anaphylactic reaction (anaphylactic shock). It can develop anywhere on the body; the usual localization is the face (usually lips, eyelids), limbs, external genitalia. The greatest danger to life is the laryngeal edema and the resulting asphyxia. Fast start and fast spontaneous resolution. Characterized by a feeling of numbness, itching, pronounced much weaker compared to urticaria.
Diagnostics
Laboratory research ... In the case of an allergic form, the determination of IgE by means of a radioallergosorbent test (especially in case of allergy to penicillin, as well as food allergens). Determination of C1q - inhibitor levels, as well as C2 and C4 components of complement in hereditary angioedema .. Decrease in C1q - inhibitor level below 100 mg / ml in type 1 .. Decrease in C4 in both types 1 and 2 .. C2 is decreased in exacerbation with types 1 and 2 .. In patients with acquired forms of C1 - inactivator deficiency, C1 is also reduced (in contrast to congenital forms).
Differential diagnosis ... Diffuse subcutaneous infiltrative process. Contact dermatitis. Lymphostasis (lymph edema). Thrombophlebitis. Local edema with somatic pathology. Granulomatous cheilitis. Erysipelas with marked edema. Cellulite.
Treatment
Diet... Exclusion of known food allergens (proteins of eggs, milk and wheat, fish, nuts, tomatoes, chocolate, bananas, citrus fruits) until the transition to a basic hypoallergenic diet.
Management tactics ... Protection from exposure to known provoking factors. Cold compress to relieve itching. Intubation for upper airway obstruction.
Drug therapy... Drugs of choice - see Urticaria. Take special care! Angioneurotic edema of the larynx and the resulting asphyxia are potentially life-threatening and require active therapy. Epinephrine 0.3 ml 0.1% r - s / c, as well as topically in the form of an aerosol. HA - dexamethasone 4-8 mg IM or IV, or 30-60 mg of prednisolone; in hereditary angioedema, the effectiveness of GC is doubtful. Antihistamines - dimetindene i / v, diphenhydramine, clemastine i / m, 1-2 ml.
Complications... Asphyxia caused by airway obstruction.
Course and forecast... In most patients with angioedema, the general condition suffers slightly, except in cases of airway obstruction. In chronic forms, the course and prognosis depend on the etiology and pathogenesis.
Concomitant pathology ... Anaphylaxis. Hives.
ICD-10. T78.3 Angioneurotic edema D84.1 Defect in the system
Quincke edema encoding according to ICD 10
One of the varieties of an allergic reaction that has a more pronounced and large-scale course is angioedema, or, in other words, Quincke's edema.
Worldwide quincke's edema in ICD 10 has a code T78.3... which implies a certain plan of methods and diagnostic tools, as well as therapeutic measures.
Severe swelling of the face, mucous membranes, lower or upper extremities is manifested as a result of exposure to the human body of any allergen of chemical or biological origin.
Quincke's edema has many similarities with urticaria and in most cases becomes its complication.
Quite often, these forms of manifestation of an allergic reaction pass into each other, but in the International Classification of Diseases 10 readings there are various codes, for example, urticaria is determined by the L50 code, which excludes its giant form, that is, angioedema.
Such an aggressive form of the body's reaction to an allergen carries a potential threat to human life, which is determined by the code T78.3, which contains nosology data with a certain percentage of mortality recorded. The informative value of the T78.3 code provides for first aid and a further plan for the management of patients with a severe form of an allergic reaction, accompanied by a giant form of urticaria.
Quincke's edema in the international classification of diseases considered in class XII "Diseases of the skin and subcutaneous tissue"... in the block of urticaria and erythema. The presence of a pathology code implies a single unified protocol for treating a patient in all countries of the world. Local protocols characterize reasonable deviations from unified protocols in a single medical institution.
Pathological signs of angioedema
A number of specific symptoms and subjective sensations of the patient indicate the development of Quincke's edema. Usually doctors register the following clinical manifestations:
The Quincke edema code also suggests symptomatic therapy to eliminate concomitant clinical manifestations, along with the main methods for stopping the fulminant form of allergic urticaria. https://youtu.be/rhqvtaDKssQ
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Quincke's edema causes, symptoms, first aid
Angioedema is a dangerous disease that can be fatal. Quincke's allergic edema affects large areas of the skin, connective tissues, and muscles. The mechanism of development is based on the release of plasma into the intercellular tissue due to increased vascular permeability. When it occurs in the larynx, emergency care is required, as the person may die from suffocation. It is observed mainly in children and women, but no one, regardless of gender and age, is immune from the development of the disease.
ICD code 10 places Quincke's edema in class XII, subsection "Urticaria". Pathology is considered a disease of the skin and fatty layer. A predisposition to violent reaction to stimuli can be congenital. The reason for its occurrence is based on instant allergy. High vascular permeability is explained by the release of irritation mediators from sensitized (sensitive) tissue basophils.
The causes of giant urticaria are as follows:
Development mechanism
An acute allergic reaction is the result of three mechanisms: allergenic, non-allergenic, combined type:
- With the allergenic mechanism, an allergen invades for the first time - food, medicine, pollen, the body perceives it as an antigen and produces antibodies. Increased sensitivity to stimuli occurs. Re-introduction of the allergen destroys the cell containing the antibodies. Histamine is released and edema develops.
- In the non-allergenic mechanism, histamine is released in response to insect venom, medications, food or olfactory stimuli.
- Congenital angioedema is a combined form. The blood contains complement proteins in an inactive state. A stressful situation can serve as an activator. Complements mistake host cells for antigens. Swelling occurs.
- Angio edema of the larynx is characterized by hoarseness, shortness of breath, cough. The patient's anxious mood is noted. The skin of the face first takes on a cyanotic, then pale shade. Loss of consciousness is not excluded. Lack of treatment is fraught with death.
- Local edema of different parts of the face. Lips, cheeks, eyelids swell. Eyes are watery.
- Swelling of the tonsils, palate, tongue.
- Swelling of the genitourinary formations. Agonizing state of urinary retention. These symptoms, especially in children, are accompanied by excruciating pain in the lower abdomen.
- Swelling of the brain. It is characterized by neurotic disorders and seizures.
- Retention of moisture in the digestive organs. "Sharp stomach." Dyspepsia. Peritonitis.
- the presence of allergies in relatives, in a patient, seasonality of manifestation, presence of animals at home;
- whether relatives were sick with allergies; have not responded to vaccinations. Have you had an allergy before? If so, what is its seasonality?
- During the period of weakening, intradermal tests are performed with 12-13 types of allergens.
- Redness of the insertion site is considered a positive result. The presence and intensity of the reaction indicates four variants of the result: negative, doubtful, weakly positive, positive.
- Exacerbation of sluggish infections.
- Hormone therapy.
- Age\u003e 60.
- Immunosuppressive effect - destruction of antibodies, blocking the growth and specialization of cells.
- Prevention of loss of granules by tissue basophils.
- Inhibition of the synthesis of mediators of an allergic reaction
- Decreased vascular permeability. The edema decreases, the pressure increases, the lumen of the bronchi expands.
- allergic angioedema;
- hereditary or pseudo-allergic edema.
- Vibrating. Expressed by severe itching and swelling after exposure to vibration. It is a hereditary disease, the mechanism of which has not yet been established;
- Swelling from compression. It develops as a result of tissue compression. Differs in soreness of the affected area. May be combined with urticaria. The development mechanism is also not known;
- Swelling after physical work. Also a poorly understood type of puffiness. Experts note a decrease in the manifestations of this type of health disorder as a result of systematic running;
- Cold. It develops under the influence of cold (water or air). It is combined with itching, which is not sharp. Mostly exposed skin is affected. May be secondary in some lymphoproliferative diseases.
- Initial. It is characterized by shortness of breath when lying down.
- Compensated. Air access is even more difficult. The patient can breathe only by taking deep breaths.
- Asphytic (decompensated). At this stage, breathing is shallow, skin cyanosis, convulsions appear. The patient loses consciousness.
Symptoms of manifestation
Urticaria and angioedema are observed on surfaces underlain by loose fatty tissue. These are lips, cheeks, eyelids, mucous membranes of the mouth, skin of the scrotum. Code - ICD 10, does not establish the cause of the immediate occurrence of edema. The reaction develops to various allergens. The number of factors that can cause an inadequate response of the body is constantly increasing.
Symptoms of angioedema persist for several hours or days, and treatment is urgent. Often the hives will go away on their own. It is characterized by a violent beginning, a rapid continuation.
Symptoms of Quincke's edema:
Symptoms in adults are similar to those in children. But, the main cause of giant urticaria is taking medications.
Diagnostic methods
The diagnosis is made on the basis of the clinical picture and records of the medical history. Of particular importance is information about the tolerability of medications in preparation for surgery or treatment of diseases.
The doctor is guided by the history data:
In the acute phase, laboratory diagnostics are performed:
Contraindications to samples:
First aid
Quincke's edema is a dangerous disease with a likely fatal outcome. The situation changes every second. What to do when it appears and how to help the victim? Immediately
invite an ambulance. If possible, interrupt the action of the allergen, bring the victim into a comfortable position, give an antihistamine. First aid for laryngeal edema consists in the speedy transportation of the victim to the hospital, otherwise death from suffocation.
Treatment types
Signs of urticaria and angioedema oblige the doctor to make immediate decisions. If laryngeal edema is detected, potent anti-allergic medications are immediately administered, for example, calcium gluconate or chloride, intravenously, a "hot injection" allows you to relieve angioedema. The patient is admitted to the intensive care unit or intensive care unit.
Therapeutic measures are carried out in two stages: the elimination of the acute phase, the destruction of the cause of the disease. The choice of how to treat an allergic manifestation is determined by the severity of the edema.
If anaphylaxis develops, the patient goes to resuscitators, laryngeal edema - ENT. The abdominal symptom complex is sent to surgeons. If there is no threat to life, they are sent to allergists or therapists.
The use of prednisone
Prednisolone is a systemic corticoid with anti-inflammatory, anti-edema effect. It is used to provide first aid for angioedema.
The antiallergic effect of prednisone is manifested in the following:
Prednisolone is administered intravenously according to the instructions.
Prevention of giant urticaria
Prevention is ensured by adherence to diet, elimination of contact with irritants, treatment of chronic ailments, constant use of antihistamines.
Manifestations of angioedema
Angioneurotic edema (Quincke's edema) has several types. Allergic edema is mainly found associated with exposure to various aggressive agents. The second most common is congenital angioedema caused by a gene mutation. In this case, there is a violation in the concentration or work of the C1 inhibitor.
For many people inexperienced in medicine, the name "angioedema" is practically unknown. But every more or less educated person has heard about Quincke's edema at least once in his life. In fact, these are two different names for one ailment, which has several varieties, united by common symptoms and mechanism of occurrence. Another synonym for this disease is giant urticaria.
Classification of the disease
According to the latest medical classification of diseases (ICD-10), all of the above names for ailments have one code - T78.3. and refer to adverse effects not elsewhere classified. This group of diseases includes negative effects, the causes of which are unknown, unclear and not precisely defined.
This ICD code does not include various types of urticaria, although the external symptoms of these diseases and angioedema are similar. The main reason is the same - the reaction to the effects of various allergens. But still, they have differences in manifestations and development mechanisms. In some cases, urticaria becomes a precursor to Quincke's edema.
Distinctive features
As already mentioned, both urticaria and angioedema occur as an allergic reaction of the body. Edema mainly spreads to the face, neck, extremities, and genitals. They develop very quickly - within a few minutes, the swelling can reach a maximum.
The essential difference between these ailments is that the first affects only the skin. The symptoms of Quincke's edema affect not only the dermis, but also the subcutaneous tissue, as well as mucous membranes. Therefore, with urticaria, as a rule, there is no internal edema: larynx, intestines, stomach. Therefore, puffiness of the second type is much more dangerous, since it can lead to a malfunction of the systems of internal organs. This is especially true for respiratory tract damage, which can lead to suffocation.
And one more difference between urticaria and angioedema is that in the first case, the affected skin is itchy. With angioedema, such a reaction is very rare.
A type of large urticaria
Basically, there are two types of Quincke's edema:
They have different reasons, and accordingly, the treatment of these ailments also differs. If the first type of puffiness is manifested under the influence of various allergens (drugs, pollen, food factors, insect bites, etc.), then the second is a gene mutation that is associated with a deficiency or malfunctioning of the C1-inhibitor of the complement system. It is a collection of complex blood proteins that are part of the body's immune defense.
Various factors can be a trigger for the manifestation of this ailment: hormonal changes, stressful situations, microtrauma. Hereditary angioedema is also called idiopathic.
In addition, there are a number of less common forms of angioedema that have different causes, although their symptoms are basically the same:
Symptoms and development mechanism
Despite the fact that different types of angioedema have different causes, the mechanism of their occurrence is the same. It consists in a violation of the permeability of the walls of blood vessels, as a result of which the liquid flows into the interstitial space. Hereditary angioedema develops according to the same principle, but not under the influence of allergens or physical factors, but due to a lack or abnormal functioning of the C1-compliment inhibitor.
The acquired form of angioedema can be caused by ailments of a different nature - hepatitis, malfunctions of the immune or lymphatic system, malignant neoplasms and others.
The main symptom of angioedema is the rapid, sometimes instantaneous appearance of puffiness. It can be asymmetrical, or it can completely capture the entire face, hands, genitals. This ailment is characterized by the so-called vitreous edema - transparent in appearance. In other cases, however, the affected skin turns pink.
If puffiness develops on the internal organs, symptoms of a violation in their work are added. For example, the swelling of the larynx causes shortness of breath, cyanosis and, as a result, pallor of the skin on the face, hoarseness, and a sharp cough.
In this case, the following stages of edema development are distinguished:
Swelling of the larynx is the most common cause of death in angioedema.
If swelling develops in the gastrointestinal tract, affecting the mucous membrane in the esophagus, stomach, intestinal tract, the patient may experience vomiting, diarrhea, bowel obstruction. Edema of the genitourinary system is characterized by a difficult urination process. Infrequently, swelling can affect the lining of the brain, causing symptoms typical of this condition.
It is easy to diagnose this ailment due to the rapidly developing swelling. In addition, an edematous reaction to adrenaline belongs to diagnostic procedures.
Treatment principles
As a rule, Quincke's edema is distinguished not only by its rapid development, but also by a quick end. Its duration can be calculated in hours or several days. In most cases, the swelling disappears without a trace. But a chronic course of the disease is possible, when its symptoms appear for more than six weeks.
This characteristic of angioedema does not mean that it does not require treatment. Indeed, like every disease, it disrupts the work of many body systems. In addition, swelling of the airways is fraught with death. Therefore, in this case, you must immediately seek medical attention.
Treatment of an allergic form of Quincke's edema should begin with eliminating the effects of allergens. This is the most effective treatment. Allergy tests are performed to accurately determine allergic factors. Avoiding contact with allergens is to prevent the development of puffiness. If the provoking factor is not established, the patient is prescribed an elimination diet, in which all potential allergic foods are excluded. Then, one at a time, they are introduced into the patient's diet and it is established to which product he has a response.
With the development of Quincke's edema, before the arrival of the doctor, you can put cold on the affected area to reduce the spread of the allergic reaction. Medication is also used. These are antihistamines (diazolin, loratidine, and others) used in the form of tablets or injections.
If a patient is diagnosed with hereditary angioedema, then special drugs are used, including C1-inhibitor concentrates (C1-INHIBITOR).
In any case, you should not let the disease take its course and you need to seek help from a specialist who will determine the cause of the disease and prescribe adequate therapy.
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Quincke edema encoding according to ICD 10
One of the varieties of an allergic reaction that has a more pronounced and large-scale course is angioedema, or, in other words, Quincke's edema.
Worldwide quincke's edema in ICD 10 has a code T78.3... which implies a certain plan of methods and diagnostic tools, as well as therapeutic measures.
Severe swelling of the face, mucous membranes, lower or upper extremities is manifested as a result of exposure to the human body of any allergen of chemical or biological origin.
Quincke's edema has many similarities with urticaria and in most cases becomes its complication.
Quite often, these forms of manifestation of an allergic reaction pass into each other, but in the International Classification of Diseases 10 readings there are various codes, for example, urticaria is determined by the L50 code, which excludes its giant form, that is, angioedema.
Such an aggressive form of the body's reaction to an allergen carries a potential threat to human life, which is determined by the code T78.3, which contains nosology data with a certain percentage of mortality recorded. The informative value of the T78.3 code provides for first aid and a further plan for the management of patients with a severe form of an allergic reaction, accompanied by a giant form of urticaria.
Quincke's edema in the international classification of diseases considered in class XII "Diseases of the skin and subcutaneous tissue"... in the block of urticaria and erythema. The presence of a pathology code implies a single unified protocol for treating a patient in all countries of the world. Local protocols characterize reasonable deviations from unified protocols in a single medical institution.
Pathological signs of angioedema
A number of specific symptoms and subjective sensations of the patient indicate the development of Quincke's edema. Usually doctors register the following clinical manifestations:
The Quincke edema code also suggests symptomatic therapy to eliminate concomitant clinical manifestations, along with the main methods for stopping the fulminant form of allergic urticaria. https://youtu.be/rhqvtaDKssQ
Swelling of the eyelids
A fairly common phenomenon is a symptom of both local and general diseases. In this case, a separate group is reactive edema, which develops against the background of inflammation of adjacent areas, for example, the paranasal sinuses. The eyelids of one eye (right or left) and two at once can swell. In addition, there is also a separate lesion of the upper or lower eyelid (in this case, as a rule, there is an inflammatory reaction - barley, chalazion, meibomitis or blepharitis).
Inflammation of the lower eyelid, like inflammation of the upper one, can be the result of allergic, infectious or viral lesions of the eye or internal organs.
The clinical picture may be mild or more intense. What to do if the eyelid is swollen? - the answer is unambiguous: only a timely visit to a doctor can prevent possible serious consequences, since the reasons can be very different and in the absence of adequate treatment, the inflammatory process can affect nearby organs.
The symptom of eyelid edema can be inflammatory and non-inflammatory. Inflammatory edema is accompanied by severe hyperemia (redness) of the skin, local temperature reaction and tenderness on palpation. Often, the edematous eyelid, when palpated, reveals a subcutaneous seal (barley, erysipelas, dacryocystitis, furunculosis).
Non-inflammatory edema is observed on the eyelids with diseases of the kidneys and cardiovascular system. They are always bilateral, as a rule, especially pronounced in the morning and are almost always accompanied by swelling of the legs and ascites. This symptom may become one of the first manifestations of these diseases, which will unmistakably indicate the need for an early medical examination.
Swelling of the eyelids caused by an allergic reaction is most often associated with angioedema Quincke, which is characterized by a sudden onset and the same instant disappearance. This edema is usually one-sided and very significant, not accompanied by any subjective sensations. The area of \u200b\u200bits localization is most often the upper eyelid. Allergens in this case can be food products: eggs, milk, chocolate, strawberries, citrus fruits, fish and seafood, as well as flowering plants, medicinal or cosmetic products, and other specific and nonspecific irritants.
The reasons why the eyelid is swollen
With inflammation of the eyelids, as a rule, in the areas adjacent to the eyelashes, tiny scales of a gray-yellow hue appear, and when scraped, redness is found.
This process is often accompanied by itching, loss of eyelashes, tearing, photophobia and hypersensitivity to atmospheric phenomena.
As a result of this pathological process, connective tissue is formed, the presence of which leads to deformation of the eyelid, disrupts or completely stops the growth of eyelashes and can cause eye irritation.
This condition is non-inflammatory and inflammatory in nature. In cases when the upper eyelid (or lower) swells and hurts, the process is accompanied by pronounced hyperemia, an increase in local temperature or soreness; on palpation, one can suspect the formation of barley, erysipelas, dacryocystitis or a boil. With the formation of a boil, edema of the eyelid is noted with the appearance of an abscess on it, which is painful on palpation. Conjunctivitis is characterized by less pronounced swelling of the eyelids, their adhesion to each other, which is caused by purulent or mucous discharge. With conjunctivitis, the eyeballs are swollen, reddened, and sore.
Puffiness of the lower eyelid can be caused by the following, the most common reasons:
burns, wounds or bruises;
Mkb allergy angioedema
Adverse effects, not elsewhere classified (T78)
Note .-- This heading should be used when coding for a single cause as the primary code to identify adverse effects, not elsewhere classified, caused by an unknown, uncertain or imprecise cause. In multiple coding, this rubric can be used as an additional code to identify the impact of conditions classified in other rubrics. Excludes: complications due to surgical and therapeutic intervention NEC (T80-T88)
T78.0 Anaphylactic shock due to pathological reaction to food
T78.1Other manifestations of pathological reaction to food
Excludes: bacterial foodborne illness (A05.-) dermatitis in reaction to food (L27.2). on skin contact (L23.6. L24.6. L25.4)
T78.2 Anaphylactic shock, unspecified
Allergic shock Anaphylactic reaction NOS Anaphylaxis Excludes: anaphylactic shock due to. pathological reaction to an adequately prescribed and correctly taken drug (T88.6) pathological reaction to food (T78.0) serum (T80.5) administration
T78.3 Angioedema
Giant urticaria Quincke's edema Excludes: urticaria (D50.-). serum (T80.6)
T78.4 Allergy, unspecified
Allergic reaction NOS Hypersensitivity NOS Idiosyncrasy NOS Excludes: allergic reaction NOS to adequately prescribed and correctly administered drug (T88.7) specified type of allergic reaction such as. allergic gastroenteritis and colitis (K52.2) dermatitis (L23-L25, L27.-). hay fever (J30.1)
T78.8 Other adverse reactions, not elsewhere classified
T78.9 Adverse reaction, unspecified
Excludes: adverse reaction due to surgical and therapeutic intervention NOS (T88.9)
Angioedema - description, causes, diagnosis, treatment.
Short description
Angioedema - acutely developing, rapidly passing edema of the skin and subcutaneous tissue or mucous membranes.
Etiology. Angioneurotic edema is a polyetiological disease that can be caused by both immune and non-immune factors.
Allergic - manifestation of type I allergic reaction; develops as a manifestation of sensitization to drugs (often antibiotics), food products and additives, the poison of stinging insects (bees, wasps and hornets).
Pseudoallergic - as a consequence of the direct non-immune histamine - releasing action of some drugs (salicylates and other NSAIDs, ACE inhibitors, dextrans, etc.), food products or additives (see Food Allergy).
Complement - addicted - can be inherited or acquired (as a rule, in patients with lymphoproliferative malignant neoplasms, which is associated with an acceleration of the metabolism of the C1 esterase inhibitor of the complement component by 2–3 times).
Idiopathic - the etiology is unclear.
Causes
Risk factors Atopic predisposition Taking ACE inhibitors (in 0.2% of cases) Presumably taking omeprazole (proton pump inhibitor) and sertraline (selective serotonin reuptake inhibitor).
Genetic aspects. Hereditary angioedema (* 106100, deficiency of the esterase inhibitor of the complement component C1, 11p11.2-q13, deletion of the C1NH gene in type 1, point mutation in type 2, # 61634;) is characterized by recurrent episodes of edema of the skin, upper respiratory tract and gastrointestinal tract (up to intestinal obstruction).
C1q is an inhibitor - a highly glycosylated serum protein synthesized in the liver and inhibits the proteolytic activity of the C1r and C1s subcomponents, thus preventing the activation of the C4 and C2 complement components.
Insufficiency of C1q inhibitor leads to uncontrolled activation of early complement components and the formation of a kinin-like factor, which causes an increase in vascular permeability and leads to the development of angioedema.
Most often (in 80–85% of cases), the cause of hereditary angioedema is a quantitative deficiency of C1q inhibitor (type 1), in other cases, with a normal amount of inhibitor, the cause of hereditary angioedema is its functional inferiority of C1q inactivator due to point mutation in the reactive center of the molecule (type 2).
Pathogenesis is similar to the pathogenesis of urticaria and is associated with dilatation and increased vascular permeability (mainly venules) of the deep (unlike urticaria) layers of the dermis and submucosal layer caused by allergy mediators (histamine, PG, leukotrienes), as well as complement components (primarily C3a and C5a ) and kinins.
Pathomorphology. Edema, vasculitis and / or perivasculitis involving only the subcutaneous tissue.
Clinical picture Local edema of the skin, subcutaneous tissue and / or mucous membranes with or without urticaria. Often - an integral component of a generalized anaphylactic reaction (anaphylactic shock). Can develop anywhere on the body; the usual localization is the face (usually lips, eyelids), extremities, external genitals. The greatest danger to life is laryngeal edema and asphyxia caused by it. Rapid onset and rapid spontaneous resolution. Feeling of numbness, itching, pronounced much less pronounced compared to urticaria, is characteristic.
Diagnostics
Laboratory research In the allergic form - determination of IgE by means of a radioallergosorbent test (primarily in case of allergy to penicillin, as well as food allergens) Determination of C1q - inhibitor levels, as well as C2 and C4 complement components in hereditary angioedema Decrease in C1q - inhibitor level below 100 mg / ml with type 1 Decrease in C4 in both types 1 and 2 C2 is reduced during exacerbation in types 1 and 2 In patients with acquired forms of C1 - inactivator deficiency, C1 is also reduced (in contrast to congenital forms).
Differential diagnosis Diffuse subcutaneous infiltrative process Contact dermatitis Lymphostasis (lymphatic edema) Thrombophlebitis Local edema in somatic pathology Granulomatous cheilitis Erysipelas with severe edema Cellulite.
Treatment
Diet... Exclusion of known food allergens (proteins of eggs, milk and wheat, fish, nuts, tomatoes, chocolate, bananas, citrus fruits) until the transition to a basic hypoallergenic diet.
Management tactics Protection from known triggers Cold compress to relieve pruritus Intubation for upper airway obstruction.
Drug therapy... Drugs of choice - see Urticaria. Take special care! Angioneurotic edema of the larynx and the resulting asphyxia are potentially life-threatening and require active therapy Epinephrine 0.3 ml 0.1% r - s / c, as well as topically in the form of HA aerosol - dexamethasone 4-8 mg i / m or i / c, or 30-60 mg of prednisone; in hereditary angioedema, the effectiveness of GC is doubtful Antihistamines - dimethindene i / v, diphenhydramine, clemastine i / m 1–2 ml.
Complications... Asphyxia caused by airway obstruction.
Course and forecast... In most patients with angioedema, the general condition suffers slightly, except in cases of airway obstruction. In chronic forms, the course and prognosis depend on the etiology and pathogenesis.
Concomitant pathology Anaphylaxis Urticaria.
Prevention Avoid contact with the causative factor ACE inhibitors are contraindicated Before carrying out procedures that can provoke the development of hereditary angioedema (dental interventions, intubation, endoscopy, etc.), danazol is recommended at 200 mg 3 r / day 3 days before the procedure, and immediately before it - introduction of 2 standard packages of fresh frozen plasma For long-term prophylaxis: Danazol 200–600 mg daily for 1 month, then for 5 days every 5 days. Danazol is ineffective for other forms of C1-esterase inhibitor deficiency; contraindicated in children, pregnant women, nursing mothers, with porphyria; can cause headache, weight gain, hematuria. Aminocaproic acid 1 g 3 r / day.
Synonyms Quincke's disease Quincke's edema.
ICD-10 T78.3 Angioneurotic edema D84.1 Defect in the system
Medicines and Medicines are used for the treatment and / or prevention of angioedema.
Angioneurotic edema is:
Angioneurotic edema honey.
Angioneurotic edema is an acutely developing, rapidly passing edema of the skin and subcutaneous tissue or mucous membranes.
Etiology
Angioneurotic edema is a polyetiological disease that can be caused by both immune and non-immune factors
Allergic - a manifestation of type I allergic reaction; develops as a manifestation of sensitization to drugs (more often antibiotics), food products and additives, the poison of stinging insects (bees, wasps and hornets)
Pseudoallergic - as a consequence of the direct non-immune histamine-releasing action of certain drugs (salicylates and other NSAIDs, ACE inhibitors, dextrans, etc.), food products or additives (see Food Allergy)
Complement-dependent - can be inherited or acquired (as a rule, in patients with lymphoproliferative malignant neoplasms, which is associated with an acceleration of the metabolism of the C1 inhibitor of the complement component by 2-3 r)
Idiopathic - the etiology is unclear.
Risk factors
Atonic predisposition
Taking ACE inhibitors (in 0.2% of cases)
Presumably taking omeprazole (a proton pump inhibitor) and sertraline (a selective serotonin reuptake inhibitor).
Genetic aspects. Hereditary angioedema (HAE) (* 106100, deficiency of the esterase inhibitor of the complement component Cl, Ilpll.2-ql3, deletion of the C1NH gene in type 1, point mutation in type 2, R) is characterized by recurrent episodes of edema of the skin, upper respiratory tract and gastrointestinal tract (up to intestinal obstruction)
Clq inhibitor is a highly glycosylated serum protein synthesized in the liver and inhibits the proteolytic activity of the Clr and Cls subcomponents, thus preventing the activation of the C4 and C2 complement components
Insufficiency of the Clq inhibitor leads to uncontrolled activation of early complement components and the formation of a kinin-like factor, which causes an increase in vascular permeability and leads to the development of angioedema.
Most often (in 80-85% of cases), the cause of HAO is a quantitative deficiency of the Clq inhibitor (type 1); in other cases, with a normal amount of the inhibitor, the cause of HAO is its functional deficiency of the C1 inactivator due to a point mutation in the reactive center of the molecule (type 2) ...
The pathogenesis is similar to the pathogenesis of urticaria and is associated with dilatation and increased vascular permeability (mainly venules) of the deep (as opposed to urticaria) layers of the dermis and submucosal layer caused by allergy mediators (histamine, prostaglandins, leukotrienes), as well as complement components (primarily C3a and C5a) and kinins.
Pathomorphology. Edema, vasculitis and / or perivasculitis involving only the subcutaneous tissue.
Clinical picture
Local edema of the skin, subcutaneous tissue and / or mucous membranes, with or without urticaria
Often - an integral component of a generalized anaphylactic reaction (anaphylactic shock)
It can develop anywhere on the body; the usual localization is the face (usually lips, eyelids), limbs, external genitalia. The greatest danger to life is laryngeal edema and the resulting asphyxiation
Fast start and fast spontaneous resolution
Characterized by a feeling of numbness, itching, pronounced much weaker compared to urticaria.
Laboratory research
In case of an allergic form - determination of IgE by means of a radioallergosorbent test (primarily in case of allergy to penicillin, as well as food allergens)
Determination of the levels of Clq-inhibitor, as well as C2 and C4 complement components in hereditary angioedema
Decrease in Clq inhibitor levels below 100 mg / ml in type 1
Decrease in C4 in both types 1 and 2
C2 is reduced during exacerbation with